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Novel Textbook Outcomes following emergency laparotomy: Delphi exercise.

David N Naumann1, Aneel Bhangu1,2, Adam Brooks3

  • 1Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

BJS Open
|July 1, 2024
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Summary

International experts established textbook outcomes for emergency laparotomy patients. These define ideal early and longer-term recovery, ensuring comprehensive patient care following complex abdominal surgery.

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Area of Science:

  • Surgical Outcomes Research
  • Patient-Centered Care
  • Global Health

Background:

  • Textbook outcomes define ideal patient experiences but are lacking for emergency laparotomy.
  • Emergency laparotomy is a high-risk procedure with significant patient morbidity and mortality.
  • Establishing consensus on desired outcomes is crucial for improving care quality.

Purpose of the Study:

  • To achieve international consensus on textbook outcomes for emergency laparotomy.
  • To define ideal early and longer-term outcomes for both non-trauma and trauma patients.
  • To involve both expert clinicians and patients in outcome definition.

Main Methods:

  • A modified Delphi exercise involving 337 participants from 53 countries across three rounds.
  • Separate outcome measures were considered for non-trauma and trauma emergency laparotomy.
  • A patient engagement exercise informed the final round of expert consensus.

Main Results:

  • Agreed early textbook outcome for non-trauma: discharge without serious complications (Clavien-Dindo ≥ grade III).
  • Agreed early textbook outcome for trauma: discharge without unexpected transfusion or serious complications (adapted Clavien-Dindo ≥ grade III).
  • Agreed longer-term outcome for both: achieving early outcome and baseline quality of life restoration at 1 year.

Conclusions:

  • International consensus reached on early and longer-term textbook outcomes for emergency laparotomy.
  • Defined outcomes provide a benchmark for ideal patient recovery after emergency laparotomy.
  • Clinical validation of these agreed-upon outcomes using patient data is the next critical step.